Page 2 - One Nursing Home's Journey

bility, she says. “We helped a few people find jobs at other places.”
Others no longer measured up: “We have asked people to leave for behav- iors we tolerated for years...we have a decreased level of what we’re willing to accept,” says Heath.
As for census, Lenawee is full with a waiting list while the three other area facilities have empty beds.
”People who want to come here sometimes have to first go to one of the other local nursing homes until we have an opening. Meanwhile they stay on our waiting list,” says Aube.
A Four-Year Process
Lenawee’s change to households was a four-year process. After becoming a registered Eden Alternative facility in 1999, the nursing home began a vigor- ous campaign to bring all interested par- ties—including the outside community and local and state government—into helping plan the next steps of its culture change journey (see Culture Change Now! Vol. II, pp. 5-7). Staff education and train- ing, learning circles and self-led action teams were part of the daily regimen.
“We each had a chance to speak our minds about how we felt and what our fears were,” says Angie Garland, CNA.
“People who were afraid to say what they really thought put it on paper...you had every chance.”
Physical renovation was completed and residents moved into their new digs in August 2003. (The first household, Green Gables, had opened months ear- lier and served as a model for the next six.) Initially called neighborhoods, the units today comprise seven households of 12-22 residents.
Construction is underway on a new, eighth household that will include 20 pri- vate rooms, a fully-functioning kitchen (with commercial-grade appliances and venting systems) and laundry. When it is completed, more than half of the nursing home’s beds will be in private rooms.
“I think eventually we’ll have to have all private rooms,” says Aube.
The new household will reduce the number of residents in the two largest, existing households from 22 to 12, there- by enabling more privacy for everyone.
Funding for the $3.2 million proj- ect is provided in part by the State of Michigan’s Long-Term Care Facility Innovation Design Supplemental (FIDS) Program—an initiative aimed at encour-
aging nursing homes to replace their aging infrastructures with one of a half- dozen or more state-approved culture change models (see sidebar and accompa- nying story on page 14).
Lenawee’s New Model
The current households each have a residential-style kitchens, dining and living rooms and small, private spaces. The central nurses’ station was removed and large public areas broken into small- er rooms for lounging and socializing. A playground for visiting children lies just outside one household. (See Culture Change Now! Vol. III, for more on physical design principles for the Household Model).
The organizational command struc- ture was flattened, bringing decision- making closer to residents. Activities, dietary and housekeeping are decentral- ized; their staff members now work in the households.
“We have an activities person down each hall, whereas there used to be only one or two for the whole building,” says Garland. “If residents don’t like (the planned activity) in our household,
eggs in the households, but we can’t fry bacon and those kinds of items,” says Aube. Instead, they buy pre-cooked bacon, sausage, pancakes and waffles and heat them in the household microwaves and toasters. Salads and the occasional des- sert are also prepared in the household
kitchens.
The new dining experience brings
staff and residents closer together, says Wendi Meijer, CNA. “We’re not just rushing them in, getting the trays out of the cart, putting them down and walk- ing away. Now it’s a more relaxed atmo- sphere. Instead of just standing there, I can sit down and have a cup of coffee with a resident and we can talk about what’s going on.”
A self-led work team with a Household Coordinator and a Nurse Leader at the helm is permanently assigned to each household. The former is responsible for coordinating all non- nursing aspects of the household. Both split their time between their leadership and primary roles.
To increase versatility among house-
Cont. on next page.
Lenawee County Medical Care Facility
Adrian, MI
they can go to one in another household.” Most breakfast items are prepared in the household kitchens. But since the appliances and venting systems there are not commercial grade (a purchas- ing decision Aube now regrets) and therefore do not conform to fire codes, lunch, dinner and some breakfast foods still come from the central kitchen in large crock pots and are served restaurant-style
in the cozy, household dining rooms. “The Fire Marshal allows us to cook
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